These hardened areas prevent the erectile tissue from expanding evenly during an erection, causing the erect penis to appear bent, curved, or otherwise deformed.

If you notice any changes to your penis, seek early consultation with an andrologist or urologist!

Get in touch

Severity and Progression of Peyronie’s Disease

Various estimates suggest that approximately 10% of all men will be affected by acquired penile curvature at some point in their lives. While plaques sometimes cause only minor indentations, most affected patients experience a visible bend.

Peyronie’s disease typically progresses in two phases: an acute (inflammatory) phase and a chronic (post-inflammatory) phase.
During the acute phase, the plaque develops — often accompanied by pain (typically during erection, but sometimes also in the flaccid state) — and the curvature gradually forms. This phase can last up to 18 months, during which the deformity may continue to develop. Only once the chronic phase is reached does the curvature stabilize and pain subside.

Depending on the extent of the IPP plaque, three degrees of severity can be distinguished:

• Mild curvature (< 30°):
  The bend is often barely noticeable and usually causes no problems during intercourse.
• Moderate curvature (30–60°):
  Curvatures in this range are typically already associated with limitations during sexual intercourse. The curvature often also leads to a shortening of penile length.
• Severe curvature (> 60°): Severe cases can significantly impair or even make intercourse impossible. Such a pronounced curvature is usually accompanied by a reduction in penile length of two to three centimeters. Erectile dysfunction frequently occurs alongside severe curvature.

< 30°

30–60°

> 60°

Deformity Patterns

Depending on where and in what orientation the pathological scar tissue forms, different deformity patterns emerge.

In Peyronie’s disease, a distinction is therefore made between:

• Curvatures — bends in a single direction, and
• Deformities without a classical bending direction, such as constrictions and indentation defects.

Combinations of these forms can of course also occur. A large proportion of patients report a noticeable loss of penile length as a result of IPP.

Upward Curvature (Dorsal Flexion)

The most common form of IPP-related curvature is an upward bend — medically referred to as dorsal flexion. In this case, the plaque is located on the upper side of the penile shaft. The exact position of the plaque determines whether the curvature occurs closer to the base or the glans, as well as how pronounced it is.

Dorsal Flexion (from side)

Downward Curvature (Ventral Flexion)

When the plaque is located on the underside of the penile shaft, it results in a downward bend — known as ventral flexion. This form is considerably less common than dorsal flexion, but can be equally distressing. Sensation during intercourse is particularly affected in more severe cases.

Lateral Curvature (Lateral Flexion)

When plaque forms on the side of the penile shaft — either to the left or right — a sideways curvature develops. This too can in some cases be very pronounced, reaching up to 90°. Lateral curvatures are often experienced by those affected as particularly burdensome. Penetration is usually no longer possible with a severely laterally curved penis.

Lateral Flexion (from top)

Constrictions & Indentation Defects

A particular form of IPP is the hourglass deformity. It occurs when the plaque does not form longitudinally but rather circumferentially — wrapping around the shaft. The result is a visible indentation or constriction of the penile shaft, giving the penis an hourglass-like shape during erection.

This form is not necessarily accompanied by a curvature, but can significantly impair intercourse and is experienced as very distressing by those affected.

Hourglass phenomenon in Peyronie’s disease

In some cases, plaques develop at multiple sites or in different directions, leading to combined curvatures — for example, a simultaneous bend upward and to the side. Such combined forms are more complex to treat and require individualized surgical planning.

Treatment of Acquired Penile Curvature

The treatment options for Induratio Penis Plastica differ depending on the phase of the condition. During the acute inflammatory phase, the primary focus is on pain relief. Treatment is conservative, using pharmacological and/or physical therapy.
Only after a curvature or other deformity has stabilized in the chronic phase can surgical correction be considered. This can only be achieved surgically; however, a wide range of surgical approaches for IPP correction is now available.
Medical guidelines from various specialist societies recommend surgical correction for curvature angles of 30 degrees or more. However, the degree of curvature should not be the sole criterion for or against surgery.

If you notice any changes to your penis, seek early consultation with an andrologist or urologist!

Get in touch!

Der Beitrag The Different Forms of Penile Curvature in Peyronie’s Disease erschien zuerst auf Dr Kuehhas.

This article aims to clarify the subject and distinguish fact from myth to provide a solid foundation for one of the most personal decisions parents can make for their son and men can make for themselves.

Circumcision is one of the most commonly performed surgical procedures worldwide.

For billions of people, it is not primarily a medical procedure, but rather a deeply rooted cultural and religious practice. Today, the Jewish and Muslim traditions are particularly well known:

• Brit Mila (ברית מילה): In Judaism, circumcision is a central religious commandment. It is traditionally performed on the eighth day of a newborn boy’s life by a so-called mohel. This procedure is highly ritualized and symbolizes the covenant between God and the Jewish people for devout Jews.
• Chitan / Khitan (ختان): In many Islamic cultures, circumcision also takes place during childhood – however, the age varies greatly from region to region, ranging from a few days to adolescence. Here, too, religious purity is the main focus, with medical and hygienic reasons often cited as additional factors.

Regardless of the medical debate, these practices are an expression of identity and belief and should be viewed with respect.

In North America, for example, circumcising boys was common because it was considered more hygienic. Over time, the circumcised penis has also become the beauty standard in many Western countries.

False diagnosis of phimosis as the most common “medical” reason for circumcision in boys

Here in Europe, however, the most frequently cited reason for circumcision in childhood is phimosis, or tightness of the foreskin. Many parents become concerned if they are unable to retract their toddler’s foreskin.

However, in most cases this is a completely normal stage of development: in almost all newborn boys, the foreskin is stuck to the glans (conglutination) and the opening of the foreskin is still very narrow, meaning that the foreskin cannot be pulled back.

This physiological phimosis is not a pathological condition, but rather an evolutionary protective mechanism, as the foreskin protects the sensitive glans and the opening of the urethra from friction, dehydration, and infections. In most cases, this adhesion of the foreskin resolves itself completely during the first few years of life.

Important: Never try to pull back your child’s foreskin by force! This can lead to small tears, scarring, and ultimately to pathological phimosis.

For many years, a flawed study by British pediatrician Douglas Gairdner from 1948 was cited, which stated that the foreskin of boys must be retractable by the age of 5 at the latest, leading to numerous misdiagnoses of pathological phimosis in the following decades. More recent studies show that about half of all boys under the age of 10 cannot fully retract their foreskin and that physiological phimosis can actually persist into puberty without being pathological.

When is treatment for phimosis necessary?

Treatment for a tight foreskin is only necessary if the phimosis has not resolved during puberty, if symptoms only appear later in life, and/or if it causes problems.

Such problems include, for example:

• Balanitis and balanoposthitis: Recurrent inflammation of the glans or foreskin.
• Painful erections: When the foreskin does not allow for an erection without causing pain.
• Secondary phimosis: When the foreskin becomes diseased and an inelastic, scarred ring forms.
• Lichen sclerosus: A chronic skin disease, especially in the genital area.
• Pain when urinating: This occurs when painful urine retention causes the foreskin to swell (“ballooning”).

Complete or absolute phimosis occurs when the foreskin cannot be pulled back over the glans, even when the penis is flaccid. In contrast, with incomplete or relative phimosis, pulling back the foreskin is difficult only when the penis is erect.

Conservative treatment or circumcision?

When pathological phimosis is present and requires treatment, surgery has long been the standard therapy. However, circumcision as a treatment for foreskin tightness can often be avoided today. Modern medicine prefers to treat phimosis conservatively.

For example, through:

• Topical ointment therapy: An ointment containing cortisone is applied to the tip of the foreskin over a period of four to eight weeks. This makes the skin more elastic and stretchy.
• Gentle stretching: Accompanying the ointment therapy, the foreskin is carefully and painlessly stretched.
• Loosening adhesions by carefully moving the foreskin.

The success rates of these methods are excellent, at over 80%. It is painless, avoids the risks of surgery, and preserves the foreskin in its entirety.

If the foreskin cannot be pulled back over the glans without pain or if you experience severe pain during an erection, discuss the problem with a urologist.

Request an appointment now!

Surgical treatment by circumcision

At the same time, surgical treatment of phimosis still has its place.

• Circumcision: The classic circumcision, in which the foreskin is completely or partially removed and the glans is then exposed.
• Preputioplasty: As an alternative to conventional circumcision, there are approaches to foreskin-preserving surgery. However, these techniques are quite complex, so they are only performed by very few doctors.

Circumcision can be performed using various techniques: in addition to the classic incision with a scalpel, there are various clamping and ligation techniques (e.g., Gomco or Plastibell) and even circumcision with a medical laser.

The debate: circumcision pros and cons

Apart from medical circumcisions, there is an intense debate surrounding the routine circumcision of infants, toddlers and boys.
Critics argue above all that children are not capable of giving consent, and that circumcision without medical necessity violates the child’s right to physical integrity and is therefore contrary to the child’s welfare.
The most common argument is that removing the foreskin reduces the sensitivity of the glans, making it difficult to have a fulfilling sex life later on. Psychosexual consequences are also sometimes mentioned.
On the one hand, advocates of circumcision cite the cultural and religious traditions mentioned above and the social component of “belonging.” They also argue that circumcision makes intimate hygiene easier, which reduces the risk of certain infections. Various studies do indeed indicate a lower risk of urinary tract infections and some sexually transmitted infections (STIs) such as HIV, HPV, and herpes.

From a technical standpoint, it’s important to note that, in the absence of clear medical indications, the decision to circumcise is a personal one that parents make primarily for social, cultural, and religious reasons.

Late decision to undergo circumcision in adulthood

Of course, it is a completely different matter for men who decide to undergo circumcision as adults. There are many reasons for this: in addition to medical reasons, such as acquired phimosis or recurrent inflammation, personal wishes also play a role here.
Above all, the aesthetic appearance of the penis plays a major role for many men. Partly due to the easy access to pornography, where 99% of male performers are circumcised, some men perceive the circumcised penis as the norm and feel the desire to adapt their own body image to this norm.
A man who decides to undergo circumcision for purely aesthetic reasons, because he feels more comfortable, confident, or “clean” with the appearance, is therefore making an autonomous decision.

Conclusion

Circumcision is sometimes a controversial topic. It touches on religion, culture, ethics, and medicine. While patience and conservative methods should clearly be the focus in cases of physiological phimosis in childhood, the decision is a deeply personal one when there are no medical reasons. In adults, however, circumcision is an act of individual self-determination.

If you have any questions or would like a personal consultation—whether for your son or for yourself—please do not hesitate to make an appointment.
Open and honest information is the key to making a decision that you will feel comfortable with in the long term.

Request an appointment now!

Sources

• • S2k-Leitlinie Phimose und Paraphimose bei Kindern und Jugendlichen, Deutsche Gesellschaft für Kinder- und Jugendchirurgie e.V. (DGKJCH) https://register.awmf.org/de/leitlinien/detail/006-052
  • Gairdner D (1949).”The fate of the foreskin.”, Brit Med J2: 1433-7, https://www.cirp.org/library/general/gairdner/.
  • Denniston GC, Hill G. Gairdner was wrong. Can Fam Physician. 2010 Oct;56(10):986-7. PMID: 20944034; PMCID: PMC2954072.
    https://pmc.ncbi.nlm.nih.gov/articles/PMC2954072/
  • Seidenberg M, Nolte J, Azad M, et. al.: Entwicklung der Vorhaut, https://flexikon.doccheck.com/de/Entwicklung_der_Vorhaut

Der Beitrag Circumcision in boys and infants erschien zuerst auf Dr Kuehhas.

However, before these treatments became routine, many men risked their health, their penises, or even their lives to fulfill their desire for a larger penis. Unfortunately, this still happens today.

In Germany, for example, a man died of blood poisoning in 2020 after his partner repeatedly injected silicone oil into his penis and scrotum at his own request.

In countries of the former Eastern Bloc and Asia, charlatans still inject silicone, paraffin, wax, oil, and other substances into men’s penises to make them larger. Men also “treat” themselves with these risky techniques. The consequences are devastating.

This dangerous method originated in Vienna during the imperial era

In fact, this dangerous practice can be traced back to the Austrian physician and surgeon Robert Gersuny, who is considered the inventor of paraffin injections.

At the turn of the 19th century, he began injecting his patients in Vienna with Vaseline, and later other mineral oils and paraffins, under the skin to model “subcutaneous prostheses.” It was not until many years later that it became clear that the material injected in this way leads to lipogranuloma—a tumor with which the organism reacts to foreign substances based on oil and wax.
A lipogranuloma often develops years after the foreign body has been introduced, but then progresses all the more rapidly. Initially, nodules form around the foreign body in the tissue, followed by inflammation, tissue death, and sometimes severe pain.

The name of this immune reaction sometimes depends on the material that triggered it: if paraffin was injected, for example, it is referred to as a paraffinoma; if Vaseline was inserted, the tumor is also referred to as a vaselinoma in the specialist literature.

Paraffinoma of the penis

The injection of paraffin, petroleum jelly, and other mineral oils for penis enlargement became a widespread practice in Europe in the first half of the 20th century. As a result, paraffinoma of the penis was unfortunately not a rare phenomenon for a long time.

Once the side effects and consequences of this “treatment” became clear, this method of penis thickening disappeared, at least in Western industrialized countries. As already mentioned, it is rare but does happen that men come to specialists with paraffinoma of the penis after self-injection or “treatment” by medical laymen.

Treatment of penile paraffinoma

When patients with complications visit a urologist or andrologist , the penile paraffinoma is usually already quite advanced. One or more surgical procedures are then performed to remove the paraffinoma as completely as possible.
In the best case, radical circumcision can remove most of the paraffinoma; in the worst case, a penectomy, i.e., amputation of the entire penis, may be necessary.

Additionally, attempts are made to support treatment with hormone injections (glucocorticoids, corticosteroids, etc.).

Since the surgical removal of the tumors can sometimes be very radical, the patient’s penis must then be corrected or
even completely reconstructed in cosmetic surgery.

Warning against dubious promises

Penis enlargement by experienced specialists is now medically possible and has become a routine procedure. Penis lengthening is possible through ligamentolysis (surgical severing of the penile ligaments). A thicker penis can be achieved through autologous fat transplantation and the use of hyaluronic acid. In the USA, a penis implant made of medical silicone is now also approved.

 If you want a larger penis, it is possible! BUT: Do not fall for false promises made by medical laymen or dubious providers abroad or unreliable websites. NEVER allow any substances or miracle cures to be injected into your penis, and do not do this yourself.
Self-treatment with tablets, capsules, dietary supplements, or creams is also strongly discouraged. At best, these have no effect; at worst, they can cause nasty side effects.

Be careful with methods for “natural penis enlargement” such as jelqing or other massage techniques: if performed incorrectly or excessively, such stretching exercises can lead to painful and serious injuries to the penis.

Der Beitrag Paraffin, oil, silicone: dangerous methods of penis enlargement erschien zuerst auf Dr Kuehhas.

The exact cause of why and when PD develops has not yet been conclusively clarified.

If you notice any changes in your penis, see an andrologist or urologist at an early stage!

Request an appointment now!

Injuries likely trigger for PD

Penile injuries are considered to be the trigger for the occurrence of PD. However, this does not have to be a single incident; many small “micro-injuries” that occur during sexual intercourse, masturbation, or even sports can also be the cause.

However, not every man who injures his penis will develop acquired penile curvature. The penis only curves if there is an excessive healing response and plaque formation. It is therefore assumed that some people are more susceptible to PD than others due to their genetic makeup.

Genetic predisposition to PD

There are several indications supporting the hypothesis that natural gene mutations could play a role in the development of acquired penile curvature.

Familial clustering

The fact that there are families in which the condition occurs frequently suggests a genetic predisposition. Studies have shown that if the father or brother already suffers from PD, the probability is significantly higher that the son or brother will also develop PD.

Thus, PD itself is not hereditary, but parents may pass on the predisposition to their children through their genes.

Ethnicity

Belonging to certain ethnic groups also appears to be associated with a predisposition to developing PD. According to a US study from 2023 involving over 17,600 participants, 71% of those affected were of Caucasian descent, 15% were African American, approximately 6% were Hispanic, 2% were Native American, and less than 1% were of Asian descent.

These findings suggest that genetic changes may play a role in the development of the disease. These can cause excessive thickening and scarring of the connective tissue. However, it is still unclear exactly which genes are responsible.

Other risk factors for developing PD

In addition to these genetic predispositions, other factors can also increase the risk of developing acquired penile curvature.

Age

The penis changes with age. The older you get, the higher the risk of developing penile curvature. Although younger men can also develop PD, acquired penile curvature mainly affects men over the age of 40. It is estimated that up to 10% of all men develop penile curvature during their lifetime.

Autoimmune diseases

In addition, men who suffer from certain autoimmune diseases such as Sjögren’s syndrome or lupus are likely to have a predisposition to PD. This is because PD occurs significantly more frequently in these patients.

In these diseases, the immune system produces antibodies that attack the body’s own tissue. These antibodies can also attack cells in the penis and cause the formation of scar tissue.

Connective tissue disorders

Patients suffering from connective tissue disorders are also disproportionately affected by penile curvature. For example, patients with Dupuytren’s contracture (a disorder of the connective tissue in the palms of the hands) , Ledderhose disease / Plantar fibromatosis (connective tissue disorder in the soles of the feet), or plantar fasciitis (inflammation of the sole of the foot) are also very often affected by Peyronie’s Disease.

If you notice any changes in your penis, see an andrologist or urologist at an early stage!

Request an appointment now!

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If you notice any changes in your erection, see an andrologist or urologist early on!

Request appointment now!

How does an erection actually develop?

It all starts with sexual arousal, which is triggered by visual, auditory, olfactory or even tactile stimulation. The arousal is transmitted from the brain to the penis via the nervous system. The nerve fibers in the penis trigger a series of chemical and hormonal processes, which lead to relaxation of the muscles and dilation of the blood vessels in the penis.

The dilated blood vessels increase the blood flow into the erectile tissue, the penis becomes larger and the tissue stiffens. At the same time, the nervous system reduces the outflow of blood from the penis in order to maintain the erection.

As soon as sexual stimulation decreases or ends, the body activates the enzyme phosphodiesterase-5 (PDE-5). This ensures the breakdown of the messenger substances responsible for the dilation of the blood vessels and thus reduces the blood flow in the erectile tissue again. The penis returns to its normal size and becomes flaccid again.

How does erectile dysfunction develop?

Erectile dysfunction does not usually develop overnight, but often develops gradually and can vary in severity.

For example, an erection may be difficult to achieve at first, but when the penis stiffens, the erection is hard enough and lasts long enough for penetration to be possible. Other men find it difficult to achieve and maintain the necessary hardness. In some cases, there is no erection at all: The penis remains flaccid even during sexual stimulation.

What can cause erectile dysfunction?

Erectile dysfunction can have various causes, ranging from physical illnesses to psychological factors.

The most common physical causes include

• Diabetes
• High blood pressure
• Cardiovascular diseases (cardiovascular system)
• Disorders of the hormonal balance
• Neurological diseases
• Surgery in the pelvic area

Psychological factor

• Stress and anxiety
• Depression
• Relationship problems
• …

Lifestyle also plays a role. A potency disorder can be directly or indirectly related to obesity, smoking, excessive alcohol abuse, drug use or lack of exercise.

Treatment options for erectile dysfunction

In order for erectile dysfunction to be treated successfully, it is extremely important to determine the underlying problem. A detailed discussion with the treating doctor and comprehensive diagnostics are therefore the basis for every further treatment step.

The options for treating erectile dysfunction include

• Drug therapy: Oral (with PDE-5 inhibitors such as Viagra or Cialis) or via gel or injections (prostaglandin E1)
• Hormone replacement therapy
• Physical erection aids: Penis pumps or penis rings support the blood flow
• Extracorporeal shock waves can stimulate the formation of new blood vessels
• In severe cases, erectile tissue implants may be the best solution for regaining erectile function.

If you notice any changes in your erection, see an andrologist or urologist as soon as possible!

Request appointment now!

What can “men” do themselves for a hard erection?

There are various measures that “men” can take themselves to prevent erectile dysfunction or improve erection quality.

For example, regular exercise can help to improve blood circulation and increase erectile function. Exercises that train the pelvic floor are particularly helpful.

A balanced diet with plenty of fruit, vegetables and wholegrain products can help to prevent obesity and secondary diseases such as diabetes or high blood pressure. As erectile dysfunction is often directly related to these diseases, a healthy diet also helps to prevent them.

A generally healthy lifestyle with exercise and the avoidance of (excessive) alcohol and drug consumption also helps.

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However, there are actually some exercises that train the pelvic floor muscles and thus help to improve erectile function. These exercises are known as pelvic floor exercises or Kegel exercises.

If you notice any changes in your erection, see an andrologist or urologist early on!

Request appointment now!

Improved erection through targeted training

The pelvic floor muscles play an important role in erection. This is because only about two thirds of the penis lies outside the body, one third lies inside the body. This part is surrounded by certain muscles of the pelvic floor. The ischiocavernosus muscle, the bulbospongiosus muscle and the pubococcygeus muscle help to stabilize the penis during erection and maintain an erection. They are also involved in controlling urination as they close the urethra.

If the pelvic floor muscles are weak, this can lead to less blood flow to the penis and therefore a weaker and less persistent erection. Stronger pelvic floor muscles can help to control the blood flow to the penis and thus improve the erection.

The “potency muscles” can be trained like any other muscle and strengthened through targeted exercises. Regular training of the pelvic floor helps to maintain and even improve the erectile function of the penis.

Potency training of the pelvic floor

There are numerous exercises to strengthen the pelvic floor for harder erections and longer stamina.

Pull inwards

Sit upright on a chair. “Pull” your penis, testicles and anus inwards using your pelvic floor muscles. Try to do this without tensing your gluteal muscles. Hold the tension for about 5 seconds before letting go again. Relax briefly and repeat this exercise about 5 – 10 times.

Interrupting the jet

Stand upright. Tense your pelvic floor muscles as if you wanted to stop the stream when urinating. Hold the tension for 5 seconds and then relax for 5 seconds. Repeat this exercise about 5-10 times per session. You should actually perform this exercise on the toilet when urinating by consciously interrupting the urine stream.

Inclined plane

Sit on the floor with your upper body upright and your legs stretched out. Support your arms slightly behind your hips on the left and right. Now lift your hips off the floor until your legs and upper body form a straight plane. Now slowly try to lift one of your legs off the floor and hold it for a few seconds. Then switch and lift the other leg up. Try to stretch each leg 3 – 5 times in the air.

The “bridge”

Lie on your back and place your feet on the floor with your knees slightly bent. Now slowly lift your hips off the floor. Your upper body and thighs should now form a straight line. Hold the tension for 5 seconds before slowly lowering the pelvis again. Relax briefly and repeat the exercise 5 – 10 times

All exercises to strengthen the pelvic floor not only help to achieve a better erection quality, but can also prevent incontinence in men.

Have problems with erections checked

It is important to note that the pelvic floor muscles are only part of the overall picture when it comes to erections. There are many other factors that can influence erectile function, such as blood circulation, the nervous system or hormone production. Potency problems can also have psychological causes.

If you notice any changes in your erection, see an andrologist or urologist as soon as possible!

Request appointment now!

Erectile dysfunction sometimes occurs as a “harbinger” of cardiovascular disease. Apart from training exercises, a healthy lifestyle not only helps to prevent erection problems but also to stay fit in general.

If you have difficulty achieving or maintaining an erection, consult a specialist. I will also be happy to help you identify the cause and show you suitable treatment options.

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However, certain types of prostate cancer grow faster and are more aggressive, and therefore require different treatment. Sometimes surgery is the only option.

During a radical prostatectomy, the entire prostate and surrounding tissue are removed to ensure that all affected tissue is eliminated.
However, a common side effect of prostate surgery is erectile dysfunction (ED).

Impotence after prostate surgery

The nerves responsible for erections are located close to the prostate. Since prostate removal surgery involves the complete or partial removal of this nerve tissue, erectile dysfunction is often the result.
Up to 90 percent¹ of men who undergo prostate surgery suffer from erectile dysfunction after the operation.

There is a high risk of nerve or blood vessel damage associated with erection during surgery for benign prostate enlargement (prostatic hyperplasia) and other pelvic surgical procedures, such as those on the bladder or intestine.

Limited treatment options

However, if parts of the nerve bundles responsible for erections can be spared during the procedure, erectile function can be improved with the administration of PDE-5 inhibitors. If the nerve fibers have been completely removed or severed, Viagra, Cialis, and other similar drugs are ineffective.

Sometimes, prostaglandin E1 can be administered to induce an erection. This medication can either be dripped into the urethra or injected into the erectile tissue using a syringe.

Penile prosthesis as a solution after prostate removal

The most promising method for treating erectile dysfunction after prostate cancer is the implantation of a penile prosthesis.

During the procedure, two silicone cylinders are inserted into the erectile tissue, which will take over the erection mechanism.

The hydraulic penile prostheses primarily used today consist of several interconnected components and imitate the natural erection mechanism: A small pump, which is “hidden” in the scrotum, allows saline solution to be pumped from a small fluid reservoir in the abdomen into the cylinders in the penis. This causes the penis to become erect.

After sexual intercourse, the saline solution is simply released back into the reservoir and the erection subsides.

A penile prosthesis is not a prosthesis in the conventional sense. It does not replace the penis itself, but only the erectile tissue. The implant is inserted into the erectile tissue, so the entire system is hidden inside the body and is therefore not visible or detectable to outsiders.

Studies examining patient and partner satisfaction with various treatment options for erectile dysfunction have shown that penile prosthesis implantation has the highest satisfaction rate of all the treatment options. Hydraulic erectile tissue implants achieved satisfaction rates of up to 98%.

Penile prostheses can also treat erectile dysfunction and impotence following radical prostatectomy, prostate surgery, or other pelvic surgeries.

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A wide variety of methods have emerged for the removal of the foreskin.

Freehand technique

The classic method, especially for circumcision in adult men or corrective circumcisions, is the freehand method (“cuff technique”). Here, the operating physician removes the foreskin with a scalpel (and, if necessary, surgical scissors) along two defined lines. The resulting ends are then sutured together again.

Depending on the desired style of circumcision, it is decided where the two incisions are made. Accordingly, more or less foreskin remains. In addition to the freehand technique, there are other circumcision techniques that use special tools.

Clamping techniques

Over the years, various companies have developed special clamps that clamp the foreskin so that blood loss is very low and the scar is as beautiful and even as possible.

When using the Morgan clamp, the foreskin is first pulled tightly over the glans. The protruding part of the foreskin is taken into the clamp. Using a scalpel, the clamped skin is finally removed. However, this circumcision method is not suitable for every style, as only partial circumcision is possible.

The Gomco clamp is also widely used. Here, a metal bell is placed over the glans, then the foreskin is pulled over this bell and carefully clamped off. The clamped foreskin is then cut off with a scalpel.

Pliers technology

The forceps technique is similar to the Morgan clamp. The foreskin is first pulled over the glans and the protruding part is grasped with forceps. The skin is pinched off by the forceps and cut off along the forceps by scalpel. The cut ends are then sutured together.

Plastibell Bell & Circ Ring

Two methods that are primarily used for small children, but should not be omitted from this list, are the Plastibell method and the use of the Circ Ring.

With the Plastibell method, a plastic bell is pushed over the glans, the foreskin is pulled over it and tied off with a plastic thread. The foreskin, which is tied off in this way, detaches completely by itself within a few days and falls off with the bell. Thus, there is no incision and a smooth scar.

The Circ-Ring is based on the same principle. Instead of a bell, a ring is inserted between the glans and the foreskin and then tied off with a rubber band.

Laser cutting

In a modern laser incision, the surgeon uses a medical laser instead of a scalpel to cut through the skin. Due to the high temperature of the laser directly at the incision site, there is no or minimal bleeding.

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Sex as circumcised man

After circumcision, man can become sexually active again after two to four weeks, once the wound is completely healed. But what is sexual intercourse like with the circumcised penis?

Usually, newly circumcised men feel somewhat “exposed” after a circumcision and find the sight of their penis takes some getting used to. After a short time, however, this feeling subsides.

Some men report a higher “stamina” during sex as well as more intense orgasms. Whether circumcision has an effect on sex life is, however, controversial.
After the foreskin is removed as “protection” for the glans, the sensitivity at the tip of the penis may well change. That this sensitivity, but also the excitability or orgasm ability changes in all men by circumcision, is not clearly proven. The fact that the climax can be delayed longer during sexual intercourse therefore probably also varies from man to man.

However, circumcision has no effect on erectile function or erectile strength.

How does circumcision affect the partner?

During sexual intercourse itself, most women do not notice any real difference. However, each has her own personal preferences. Some enjoy sex with a circumcised man, others enjoy being with an uncircumcised man. Still others may have no preference at all.

One reason some prefer a circumcised man as a sex partner is hygiene. An intact foreskin is harder to keep clean. It can also be more susceptible to infection. Therefore, many women (or men) feel more comfortable having sex with a circumcised man because they feel their risk of infection is lower. Without this concern in mind, sex can then be more pleasurable.

On the other hand, some prefer to have sex with an uncircumcised man because the foreskin feels softer and there is less friction during penetration. If the foreskin is still present, the glans is much more sensitive, so the man may not need to thrust as deeply or quickly to feel pleasure himself Therefore, uncircumcised men often penetrate their sexual partners with gentler movements.

A circumcised man lacks nothing but the foreskin during sexual intercourse. If a man or woman finds the friction during penetration uncomfortable or painful, lubricating gel helps to solve the problem.

Der Beitrag What are the effects of circumcision on sexual intercourse? erschien zuerst auf Dr Kuehhas.

However, nocturnal erections can provide information about penile health and erectile dysfunction (ED).

The “Morning Wood” & Nocturnal Erections

Normally, men have several erections during sleep. In a healthy man, the member becomes erect one to five times in one night and then becomes flaccid again. If the last of these sleep erections lasts until awakening, it is called a morning erection (colloquially known as “morning glory”).

Sleep erections occur in men of all ages, even in infants who do not yet experience any sexual desire.

This is because nocturnal erections are related to the activation of certain brain regions during the REM phase (dream phase) and are not caused by sexual stimulation.

Since the duration and frequency of REM phases increase in the morning hours, a “morning woody” is therefore more common than an erection on waking in the middle of the night.

When the morning erection is absent

A “morning glory” is a good sign of a man’s hormonal and sexual health. Nevertheless, the absence of a morning erection is not a cause for concern at first.

Waking up at a time during the sleep cycle that does not coincide with a REM phase means the penis is not erect.

The older we get, the more likely it is that the frequency of nocturnal erections will also decrease. Diabetes, cardiovascular disease or depression, and mental illness can also affect the ability to have an erection in the morning. So can certain medications.

In younger men, stress in everyday life, a time change or sleep disturbances can really mess up the sleep rhythm. As a result, the morning erection can also be interrupted.

If the nightly erections fail completely, it is advisable to discuss the problem with a urologist or andrologist.

If you notice changes in your limb, see an andrologist or urologist early!

Request appointment now!

Indicator of Erectile Dysfunction?

Erectile dysfunction can have physical as well as psychological causes. Sometimes both physical and psychological factors are involved at the same time.

If a man suspects he is suffering from ED and discusses the problem with his doctor, he will also ask him about his morning erection.

This is because if the patient still wakes up with a healthy erection, it may be an indication that his potency problems are more psychological.

However, if the affected person has also not had a morning erection for a long time, this could be due to physical causes of the problem.

Of course, the morning erection is not the only criterion for assessing erectile dysfunction.

Any andrologist will consider the person’s other medical history, physical condition, testosterone levels, medications taken, and many other points in making a diagnosis.

If you notice changes in your limb, see an andrologist or urologist early!

Request appointment now!

Der Beitrag When the morning erection is absent erschien zuerst auf Dr Kuehhas.